Multiple Sclerosis

Bladder problems are not uncommon in people with MS. It's estimated that as many as three quarters of people with MS experience them.

There are two main types of bladder problems that can occur in MS;

A problem with storage and

A problem with emptying

The most common is a dysfunction with storing urine; however some people get a bit of both. During a relapse the problem might occur or worsen, particularly if your mobility is affected.

Problems with storage

Messages from the brain to the bladder have to travel the length of the spinal cord. If these messages are interrupted, faulty reflexes can appear causing the bladder to contract from a small amount of stored urine. This is known as Detrusor Overactivity.

Detrusor Overactivity may cause sudden urges to go to the toilet which is called 'urgency'. In some cases, you might not be able to reach a toilet in time and have an accident; this is called 'urge incontinence'. You may also feel that you need to go to the toilet all the time; this is referred to as 'frequency'. You may have to wake up during the night several times to visit the toilet; this is called 'nocturia'.

These problems can occur because the muscles around the bladder do not squeeze at the right time. When you need to go the toilet and empty your bladder, the muscles around your bladder should squeeze the bladder to empty it, unfortunately with MS the muscles around the bladder squeeze at the wrong times. The most common treatments for urgency and frequency bladder problems are anticholinergic medication. This type of medication usually has a good effect on over activity of the bladder but may also hinder bladder emptying.

Problems with emptying

When a bladder empties, 2 groups of muscles should perform different jobs at the same time; the muscles around the bladder squeeze out the urine while the sphincter muscles (which usually keep the bladder outlet closed) relax to let the urine escape. In MS, these muscles can become uncoordinated which means that the muscles around the bladder will try to squeeze the bladder empty but the sphincter muscles will tighten as well, which prevents the urine from being released. This is referred to as 'dyssynergia'

In some cases, as a result of MS your bladder may not empty completely so there is some urine left when you have passed water, this is called 'residual urine'. If there is urine left in the bladder constantly, you could experience urinary infections. There are tests that can be done to check the amount of urine left in the bladder, including a bladder scan. If the level of urine remaining in the bladder is high then intermittent catheterisation could be the best way to manage retention problems. Please visit our Resources section where you will find a fact sheet describing the different kinds of catheters.

Managing your symptoms

For some people with MS who cannot manage their bladder problems with anticholinergic medication or intermittent self catheterisation, there is another treatment that has looked to be highly effective in reducing urgency and urge incontinence. This treatment involves injecting botulinum toxin into the bladder wall. You may have already heard of this treatment but you will know it as 'botox' which is most commonly used to banish wrinkles. This treatment does mean that bladder emptying can be affected and people that go through with the procedure should understand that they may have to learn to do intermittent self catheterisation following the procedure. For more information on Botox® as an option please visit our Botox page.

Further Help

This information has been provided in association with the MS Society.

You may wish to contact the MS Society for further information and support; their details are below.

The MS Trust also has a useful webpage on how people with MS can deal with bladder and bowel problems called practical guides.
If you are concerned about your bladder problem and it is starting to affect your day to day life make an appointment to see your doctor, continence nurse or specialist physiotherapist. A continence nurse and specialist physiotherapist are healthcare professionals who specialise in bladder and bowel problems. You can also call our specialist helpline on 0845 345 0165 (24 hour answerphone) for medical advice, or call our office on 01536 533255 to find out where your nearest NHS continence service is.

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